mitral valve prolapse

Mitral Valve Prolapse

Definition

Mitral valve prolapse (MVP) is a ballooning of the support structures of the mitral heart valve into the left upper collection chamber of the heart.

Description

Other names for MVP include floppy valve and Barlow's syndrome. The mitral valve is located on the left side of the heart between the top chamber (left atrium) and the bottom chamber (left ventricle). The valve opens and closes according to the heartbeat and the pressure that is exerted upon it from the blood in both chambers.

The valve has supporting structures that attach to the heart muscle to help it open and close properly. When these structures weaken or lengthen abnormally, the valve may balloon into the left atrium. Sometimes this can cause the mitral valve to leak blood backward.

This condition may be inherited and occurs in approximately 10% of the population. It affects more women than men and often peaks after the age of 40.

Causes and symptoms

MVP may occur due to rheumatic heart disease but is usually found in healthy people. Changes that occur in the valve are caused by rapid multiplication of cells in the middle layer that presses on the outer layer. The outer layer weakens, causing a prolapse of the valve toward the left atrium.

Most persons do not have symptoms. Those that do may experience sharp, left-sided chest pain. Some complain of fatigue, or a pounding feeling in the chest. Others can have an irregular heart beat and even pass out. Some persons may experience difficulty breathing, ankle swelling and fluid in the lungs. Other symptoms may include anxiety, headaches, morning tiredness and constantly cold hands and feet. Death from this condition is rare.

Diagnosis

The diagnosis of MVP is based on symptoms and physical exam. During the exam, the physician may hear a click and/or heart murmur with a stethoscope.

The best diagnostic test for MVP is the echocardiogram. The test reflects sound waves through the chest wall to give two-dimensional color flow pictures of the heart, its size, position, motion, chambers, and valves. Unfortunately, during the early 1980s, this diagnosis was often made excessively from faulty echocardiographic criteria prevalent at that time.

Any person with symptoms or family history of MVP should consider having an echocardiogram. The test takes 15-20 minutes and is done in doctor's offices and hospitals. It is performed by trained technicians and is read by cardiologists. Family physicians, internists, cardiologists, and nurse practitioners can treat MVP. Echocardiograms are recommended periodically depending on the extent of valve leakage.

Treatment

Persons who experience certain types of an irregular heartbeat with MVP should be treated. Propranolol (Inderal) or other beta blockers or digoxin (Lanoxin) are often helpful. Persons who develop moderate to severe symptoms with a leaky mitral valve may require repair or replacement of the mitral valve with an artificial heart valve. Persons with MVP and a leaky valve need to protect themselves from heart or heart valve infections. Antibiotics should be taken before any surgical, dental or oral procedures according to the American Heart Association recommendations.

Other treatments include drinking lots of fluids during strenuous activity and hot weather. Water pills, caffeine and donating blood may aggravate the symptoms of MVP.

Prognosis

MVP is usually not a serious condition. However, dangerous, untreated irregular heartbeats may rarely cause sudden death. These persons should be carefully monitored.

Mitral valve prolapse occurs when the mitral valve does not open and close properly. When this happens, the valve may balloon into the left atrium of the heart, causing the mitral valve to leak blood backward. Mitral valve stenosis refers to the narrowing of the mitral valve, in which the flow of blood from the atrium to the ventricle becomes restricted.

mitral

mitral valve prolapse (MVP) a condition in which some portion of the mitral valve is pushed back into the left atrium during ventricular contraction. For reasons not fully understood (there is no evident disease process) there is redundant tissue on one or both leaflets of the valve. The prolapsed portion of the valve causes a clicking sound halfway through the ventricular contraction, which is followed by a systolic murmur as blood is regurgitated back through the mitral valve into the left atrium. Echocardiography can demonstrate the mitral valve as it prolapses into the left atrium. Called also click-murmur syndrome and Barlow's syndrome.

The condition was first noted in association with potentially serious complications such as infective endocarditis, transient ischemic attack, and arrhythmias. However, in the vast majority of persons in whom mitral valve prolapse is detected by auscultation, the condition is benign and there are no other symptoms.

Mitral valve prolapse is found in persons of all ages and is fairly common, particularly in women. The few who have problems usually experience chest pain, dyspnea, palpitations, fatigue, and sometimes syncope. Electrocardiographic studies may show some premature ventricular contractions, but unlike those in coronary heart disease, these do not indicate injury to the heart muscle.

Persons who suffer from the above symptoms may require administration of a beta-adrenergic blocking agent such as propranolol, restriction of caffeine intake, and avoidance of heavy meals. Those with severe symptoms may require repair or replacement of the mitral valve. It is recommended that patients with mitral valve prolapse take antibiotics prior to dental procedures.

prolapse

[pro´laps]

1. the falling down or downward displacement of a part or viscus; called also procidentia and ptosis.

2. to undergo such displacement.

prolapse of cord protrusion of the umbilical cord ahead of the presenting part of the fetus in labor.

Variations of prolapsed umbilical cord. From McKinney et al., 2000.

prolapse of the iris protrusion of the iris through a wound in the cornea.

rectal prolapse (prolapse of rectum) protrusion of the rectal mucous membrane through the anus.

prolapse of uterus downward displacement of the uterus so that the cervix is within the vaginal orifice (first-degree prolapse), the cervix is outside the orifice (second-degree prolapse), or the entire uterus is outside the orifice (third-degree prolapse).

mi·tral valve pro·lapse

excessive retrograde movement of one or both mitral valve leaflets into the left atrium during left ventricular systole, often allowing mitral regurgitation; responsible for the click-murmur of Barlow syndrome, and rarely may be due to rheumatic carditis, a connective tissue disorder such as Marfan syndrome, or ruptured chorda tendinea ("flail mitral leaflet").

mi·tral valve pro·lapse

(MVP) (mī'trăl valv prō'laps)

Excessive retrograde movement of one or both mitral valve leaflets into the left atrium during left ventricular systole, often allowing mitral regurgitation; responsible for the click-murmur of Barlow syndrome, and rarely may be due to rheumatic carditis, a connective tissue disorder such as Marfan syndrome, or ruptured chorda tendinea ("flail mitral leaflet").

mitral valve prolapse

A condition of the mitral valve known as the floppy valve syndrome and present in about one person in twenty. It causes a characteristic heart murmur but is usually of no consequence. Occasionally mitral valve prolapse may lead to valve leakage, chest pain, pulse irregularity, BACTERIAL ENDOCARDITIS and, rarely, HEART FAILURE.

mi·tral valve pro·lapse

(mī'trăl valv prō'laps)

Excessive retrograde movement of one or both mitral valve leaflets into the left atrium during left ventricular systole.

Patient discussion about mitral valve prolapse

Q. I have just developed a pain in my calf - feels like it clicks when I walk, and is a sharp pain I first noticed this problem this morning. As I stepped out of my car, I felt a sharp pain in my left calf, and it has gone worse as the day has gone on. No pain until I walk.

A. hmmm...now as i think of it- fatman's answer seems more logical. but usually people can tell the difference between strained muscle and other stuff. if it was just a pulled muscle he would have thought of it and naturally massage the area. no?

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